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Tuesday, September 1, 2015

Being Mortal by Atul Gawande - Book Review by Srianee Fernando Dias

(Recommended reading for all physicians)

This book by Atul Gawande, a practicing surgeon, discusses issues related to sickness and aging and the ways in which the American health care system falls short. Most of us with roots in South Asian culture will find this book very interesting, because the author ( whose doctor parents immigrated to the U S from India) compares Western and South Asian attitudes toward aging, and the way families cope.

He uses a very personal story, that of his father, to highlight the difficulties patients confront, when faced with a serious illness. When his father developed a slow growing spinal cord tumor,the family consulted two surgeons at two separate, well-known medical centers. They received two opposing opinions, one very aggressive and the other a much more conservative management plan. His father chose the latter, and was able to continue working as a surgeon for a few more years, and was able to enjoy a decent quality of life until his inevitable demise. Had he chosen the invasive surgery, it may have resulted in paralysis and a greatly diminished quality of life.

He also writes about the lives of several other patients and their struggles. The content may be serious, but Dr. Gawande's writing style keeps one engaged until the end.

This book was written a few years ago and has been discussed extensively in the U.S. media as well as in private discussion groups. It may not have had as much publicity in other countries ( I couldn't find it in Sri Lanka), but many of the issues raised are universal.

Is it necessary to always "treat" a terminal illness, especially when the the possibility of a cure is negligible and the effects of treatment are harsh? Sometimes all we need to do is to offer palliative care to the patients with adequate pain management. Physicians often feel that they must "do something" even if there is a possibility of the patient ending up in a worse state than before. Palliative care is "doing something!"

If you get a chance, or have had a chance to read this book, I would like to hear your comments and generate a discussion on palliative care and other issues raised in this book.

17 comments:

SrianeeThis is a fine review. Thank you for bringing into focus Atul Gawande's book which I read several years ago. It is a revealing insight in to healthcare and its multiple facets when it is needed most. Perhaps it is a must read for all doctors and care professionals.ND

Thanks ND. I thought I 'd put it "Out there" for discussion, because I don' t think that palliative care is an option that is easily available to terminally ill patients in Sri Lanka. If I'm wrong, I'd like to hear about it.Srianee

Srianee,Thank you for enlightening me, as I have not read this great book -- shall try to lay my hands on one soon!!Prior to leaving SL I had worked in the remotest of places. more with only "make do clinical practices" available!! I shunned PP to which the simple village people treated me as a 'Demi- God'-- I was there 24/7 for them!! This opened my eyes.Now,my children, following in my foot steps-- ( not waiting & watching for my wallet to drop!!)- all in the NHS, with my son is following a career in 'Care of the Elderly' -- I hope he follow in Dr Gawande,s footsteps.Once again thank you for the review --its great.Razaque

Thanks Razaque. Your son may have read the book, and you should be able to find it in your local library. Two other books that he's written are "Complications" and "Checklist Manifesto." Both are related to Medicine. You would enjoy reading them. Srianee

Hi Srianee, I need to be educated! I haven't read this book and I shall put that right soon. You mentioned Palliative care which happens to be an aspect of Medicine I was very interested in. My special interest at Work was Movement Disorders (nothing to do with bowels as all of you know of course) and within that, palliative care in Parkinson's Disease. In fact I wrote the chapter on Palliative care in the book, "Parkinson's Disease in the Older Patient".

Our profession has moved on but there was a time when the desire to "treat" as you say, was paramount and the wider aspects of the duties of a Physician were forgotten. Not to intervene actively (do something) even when it was obvious that a point of no return was reached, was regarded as a failure. Palliative care is certainly "doing something"! Death is a subject which is often shunned in Western Society. People do not die here they just "pass away" and many a person has grown to adulthood without ever seeing a dead body. When a death occurs in hospital, the body is whisked away to the Undertaker and relatives often do not see a body or even a coffin. The pressure to "treat" could be very high and apart from the emotional and psychological toll, scarce resources are wasted. Palliative care and end of life care within it, are very important aspects of care and it is pleasing to see that the scope of PC has widened from what used to be associated with just Cancer. It would be useful to have views from other colleagues too.

MahenI do admire your work and service to your community as a Physician. You have touched on a very sensitive and emotive subject. Personally I would prefer to enjoy life while I can and leave those vexed questions to the healthcare professionals of today. I hope I don't sound rude or careless. That is just my way of dealing with the inevitable as I ride into the sunset.ND

Speedy and ND thank you for your comments. This is exactly what I wanted to accomplish, get a lively discussion. I hope that more people would send in their opinions/comments. Rohini Ana sent me an email and said she was having problems with Safari. Perhaps we will hear from her later. Srianee

I couldn't help posting these comments from a review of his book. I am getting one from an on line shop.Riveting, honest, and humane,

"Being Mortal shows that the ultimate goal is not a good death but a good life – all the way to the very end".

Reviews

“A deeply affecting, urgently important book – one not just about dying and the limits of medicine but about living to the last with autonomy, dignity, and joy.” – Katherine Boo.

And this by Oliver Sacks who died very recently, “We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However, it is not only medicine that is needed in one’s declining years but life – a life with meaning, a life as rich and full as possible under the circumstances. Being Mortal is not only wise and deeply moving, it is an essential and insightful book for our times, as one would expect from Atul Gawande, one of our finest physician writers.” – Oliver Sacks

I thank Mahen for bringing into focus Oliver Sacks who was regarded as the Poet Laureate of contemporary medicine. After he was diagnosed with terminal cancer he wrote “Over the last few days,” “I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts. This does not mean I am finished with life. On the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight. I cannot pretend I am without fear,” he concluded. “But my predominant feeling is one of gratitude.”ND

Dear Lucky, Srianee and Nihal,Didn't think you'd notice my absence when the blog has been roaring like a house on fire -Nihal was spot on when he said it has been set alight!I have been lost in a wilderness of account names,usernames,and passwords and haven't had time to steer myself out of the maze to contribute to the blog!In spite of my silence I have appreciated the "happenings" in the blog from time to time-the music by Mahen and Zita , the well written insight into Prof Rajasooriya's life by Nihal, the unique humour of Razaque and last but not the least Srianee's introduction of "Being Mortal" dealing with multifaceted and complex issues very relevant to us all.(by the way- where is Sriani with her jokes?)Srianee mentioned in one of her comments that I was having problems with Safari and kindly made suggestions on how to overcome it- Nihal has done the same a while ago and I do appreciate their kindness.However I realize the problem in fact lies with me!When I am confronted by requests for passwords and account names I am totally lost and just give up!I need time to get all this sorted and the latter is in very short supply-I seem always to be run off my feet with one thing or another!I shall have to make my elusive "twilight" happen before it is too late!Meantime please forgive me for not commenting on your wonderful contributions and hope you all go from strength to strength.With Best Wishes

You are not alone Rohini. I am not much ahead of you either--- just about 'keeping my head above water'!!! My son is a great help when it comes to matters IT. Only thing I could tell you is -- keep at it and you will get there,.... honestly!!---- practice makes perfect..........Hope alls well in the Antipodes. I miss the place!!!Razaque

Glad to see you again Rohini. We did miss your witty comments. There is something lively about the way you say things, just as the unique style of Razaque's humour! Please do contribute when you "sort yourself out". Posting as anonymous (from the pick list next to comment as: is the easiest way to comment.

Hi Rohini, Good luck getting your computer problems sorted out. All these digital gadgets are fun and wonderful when everything is working smoothly, but when things go wrong, you just want to tear your hair out, or whatever is left. Srianee

On this important topic I must mention Harsha Samarajiwa who treated my mother when she was terminally ill. I have written about this previous but wish to reiterate his kindness, care and exemplary professionalism all through her illness making sure she was never in pain. For my mother It was a peaceful exit from this world thanks to an exceptional doctor. That was terminal care at its best and it all happened in SL.Harsha, I have no words worthy enough to adequately thank you.ND